Freedom from Knee Pain: The Ayushman Bharat Solution
Chronic knee pain due to conditions like osteoarthritis can severely impact one's quality of life, making even simple daily activities difficult. For many, a Total Knee Replacement (TKR) surgery is the only long-term solution. However, the high cost of this surgery, especially the price of the implant, puts it out of reach for millions of families in India.
The Ayushman Bharat (PMJAY) scheme addresses this problem head-on. Knee replacement surgery is one of the key high-cost procedures covered under the scheme's ₹5 lakh health cover. This guide will explain exactly what is covered, how to find the right hospital, and the step-by-step process to get this life-changing surgery done completely **free of cost**.
Is Knee Replacement Surgery Fully Covered?
Yes. **Total Knee Replacement (TKR)** is fully covered under Ayushman Bharat. The scheme has specific, pre-defined packages for orthopaedic procedures, and knee replacement is a high-priority treatment. The scheme covers both:
- Unilateral TKR: Replacement of a single knee joint.
- Bilateral TKR: Replacement of both knee joints, if medically necessary.
What's Included in the "Free" Knee Surgery Package?
The PMJAY package for knee replacement is comprehensive, ensuring zero out-of-pocket expenses for the beneficiary. The ₹5 lakh cover includes:
- Cost of the Implant: This is the biggest expense. The price of the artificial knee joint is fully included in the package. The hospital must use implants approved by the National Health Authority (NHA).
- Hospitalization Charges: This covers room rent (general ward), ICU charges, nursing fees, and meals for the patient during their stay.
- Surgical and Doctor Fees: All fees for the orthopedic surgeon, anaesthetist, and other consulting doctors are part of the package.
- Diagnostics and Medicines: All pre-surgery investigations (X-rays, blood tests) and all medicines required during the hospital stay are covered.
- Post-Operative Care: This includes follow-up consultations and medicines for up to 15 days after discharge.
Step-by-Step Process for Cashless Knee Replacement
To avail the benefit smoothly, follow this process:
- Step 1: Get a Diagnosis from an Orthopaedic Surgeon
First, you must be examined by a qualified orthopaedic doctor who recommends a Total Knee Replacement. Get this diagnosis and recommendation in writing on a prescription.
- Step 2: Find an Empanelled Hospital with an Orthopaedics Department
This is crucial. You must find a PMJAY empanelled hospital that has a good **Orthopaedics department**. You can use the official PMJAY hospital portal and filter by "Orthopaedics" specialty in your district.
- Step 3: Visit the Ayushman Mitra Desk
Go to the selected hospital and contact the Ayushman Mitra. You will need to provide the patient's Ayushman Card, Aadhaar Card, and the doctor's prescription. If you don't have a card, they can help you get one if you are eligible. First, make sure you know how to check your name in the Ayushman list.
- Step 4: The Pre-Authorization Process
The hospital will verify your eligibility and submit an online pre-authorization request for the knee replacement package. This request includes your medical reports. The insurance company usually approves it within a few hours.
- Step 5: Receive Free Surgery and Rehabilitation
Once approved, the hospital will admit you and schedule the surgery. The entire process, from admission to surgery and post-operative care in the hospital, will be completely cashless.
Frequently Asked Questions (FAQs)
Q. Can I choose the company or brand of the knee implant?
No. The NHA has standardized the specifications and rates for implants used under the scheme to ensure quality. The hospital will use one of the government-approved implants, and its cost is fully covered.
Q. What if the doctor says I need a special imported implant?
If a doctor suggests using a specific high-end implant that is not covered under the PMJAY package, you may have to pay the difference in cost. However, the standard approved implants are of good quality and used in a majority of cases.